CREATING A VOICE FOR NURSES Erik van Muilekom MANP, OCN, RN Clinical nurse specialist Netherlands Cancer institute- Antoni van Leeuwenhoek hospital Amsterdam President EONS
European Oncology Nursing Society 2014 Charity established 1984 UK 30 European countries represented 22.000 cancer nurses Affiliated NGO s Non Governmental Organizations other cancer organisations ECCO, ESO, ONS, ISNCC, UICC MASCC, IPOS, EAUN
Austria Belgium(2) Bulgaria Czech Republic Croatia Cyprus Denmark Estonia Finland France Germany Greece Hungry Iceland Ireland EONS 2014 30 countries and 26 languages EONS = English Israel Italy Lithuania Malta Norway The Netherlands Poland Portugal Serbia Sweden Switzerland Slovenia Spain Turkey UK(2)
Vision That all people affected by cancer across Europe will benefit from the care of well educated, well informed and highly competent cancer nurses, who will play a central role in providing support, promoting health and improving clinical outcomes
Mission Working in partnership to develop and promote excellence in cancer nursing practice through education, research, leadership and support to cancer nurses across Europe
Values To be an inclusive and credible organisation, which aims to provide effective and practical support to all members across Europe. Work in co-operation with a range of multidisciplinary organizations to optimise the nursing contribution to cancer care in Europe.
CREATING A VOICE FOR NURSES Proud to be a nurse Cancer in Europe Nursing workforse Let s hear your voice Organisation Education Advanced nursing practise Patient s voice
Nursing staffing cuts to save money, effects patients, increase bachelor education for nurses could reduce hospital deaths
Nursing staffing and education and hospital mortality in EU Increase workload-increased mortality > 6 patients per nurse higher mortality More bachelor s degree nurses decrease mortality Cutting nurse staffing to same money affects patients outcomes Increase education prevent hospital deaths (Aiken et al, (2014), Lancet)
What is happening in Europe with cancer care Aging populations and professionals Fast changing treatments Change in how we deliver cancer services Many survivors patients with voices
Cancer incidence and mortality patterns in Europe: Estimates for 40 countries in 2012 Total population 733 mlj (Ferlay et al (2013) EJC, 49, 6, 1374 1403) Cancer patients 3.45 miljoen Cancer deaths 1.75 miljoen
Cancer incidence and mortality patterns in Europe: Estimates for 40 countries in 2012 (Ferlay et al (2013) EJC, 49, 6, 1374 1403)
Europe and Ageing population (United Nations New York, World Population Ageing 2013)
(United Nations New York, World Population Ageing 2013) EU countries
Facts Ageing population Increasing demand for healthcare Elderly people multiple chronic conditions (IMF.org 27-9-2012)
(Gatta G et al, 2014 Lancet Oncol) Improved survival but differences between countries, accesibility to good care, variation different reasons
Health workforce Also Aging Insufficient new recruits to replace those retiring 2010 2060 Patients > 65 years Doctors Nurses 87 million 152,7 million 30% > 55 years Age 41-45 years (EU: Action plan EU health workforce 18-04-2013)
The average age of the nurse in many countries > 40 year Canada - 44.6 Denmark - 43.8 Iceland - 44 Ireland - 41.4 Germany - 39.4 Japan - 37.9 New Zealand - 44 Singapore - 35 Thailand - 41 United Kingdom - 42 United States - 46.8* (ICN, 2007, An Ageing Nursing Workforce)
Health workforse Also Growing feminization healthcare workforce 13.1 million Women 2010=75% of the workforce Medical schools 50% women
Health workforse Also Increasing turnover health professions Due to Low pay Long working hours Stress Difficult work life balance
Balance is the key for life
Estimated shortage in EU 2020 Undersupply of health professionals rural, poor populated areas Unequel distribution of health professionals Estimated shortage 2020 Estimated % care not covered Physicians 230.000 13,5% Dentist, pharmacists and physiotherapists 150.000 13,5% Nurses 590.000 14% Total 970.000 13,8%
EU action plan Forcasting workforce needs Anticipating future skills needed in health professions Share good practice Effective recruitment What can we do as Nursing professionals
Policy: EU Green paper Progress on improving the health status of the population and providing better provision of, and access to, healthcare for all across Europe cannot be realised without a workforce of sufficient capacity and with the right skills. Promoting a sustainable workforce for health in Europe 2012
Caring in Crisis Nurses in EU work harder than before, asked to provide more for less Nurses (female) are unequally and hardest hit Lack of equipment, reduced supplies, inadequate staffing, placing patients lives in danger (European Federation of Nurses Associations, Caring in Crisis, 2012)
Current Challenges Increasing public awareness of oncology nurses potential in Europe Shortage of oncology nursing workforce Diversity of roles, titles and qualifications* Mobility Rapidly changing healthcare systems Personalized care *Schneider & Faithfull (2008) http://www.cancernurse.eu/documents/newsletter/2011spring/ EONSNewsletter2011springPage28.pdf
We have to build our own future
Let your voice hear
What is your way to get attention
Let your voice hear Who has the power What is realistic to reach Where are my friends Who are my enemies Can I make small steps When to go for it
Building a society
Dutch Oncology Nursing Society 2600 members, oncology nurses 25 years Active membership Depending on individuals Invite new members and leaders
Education of nurses is a major key to quality care and better outcomes for patients (Aikan et al, 2014, Lancet)
Improve cancer nursing care New Core Curriculum is based eight modules and focuses on the adult with cancer Can be used for curricula development for all nursing education programs Nurses working in cancer centers or in general practice/hospital settings WWW.CANCERNURSE.EU
Did cancer nursing in EU change due to EONS existence Cancer nursing as a specialty Advanced nursing practice Nursing research Differences in Europe Making progress
EONS member survey 2013 Countries cancer nursing recognized as a specialist area of nursing Belgium Practice Croatia Cyprus Denmark Estonia Finland Iceland Ireland Hungary Lithuania Norway Sweden Poland The Netherlands Turkey UK Countries cancer nursing NOT recognized as a specialist area of nursing Practice Austria Czech Republic France Greece Malta Serbia Switzerland Slovenia Portugal Spain Total: 16 10
Recognition of cancer nursing Working on a European level EONS & ESMO
Development advanced nursing practice globally (Sheer, B. 2008, Journal of Nursing Scholarship, 40,3, 204-211)
Development advanced nursing practice globally Advanced practice nursing rol expanded last decade Education programs but sometimes no jobs Requires a healthcare environment of multidisciplinarity (Sheer, B. 2008, Journal of Nursing Scholarship, 40,3, 204-211)
Advanced practic nurse A Nurse Practitioner/Advanced Practice Nurse is a registered nurse who has acquired the expert knowledge base, complex decision-making skills and clinical competencies for expanded practice, the characteristics of which are shaped by the context and/or country in which s/he is credentialed to practice. A Masters degree is recommended for entry level. (International council of Nurses (ICN) 2009)
Advanced practice nurse Educational preparation Recognition education programs Fromal system licensure, registration, certification etc.. Nature of practice Intergrates research Autonomy Consultant services etc. Regulatory mechanisms Right to diagnose Prescribe medication, treatment Recognized titles etc.. (International council of Nurses (ICN) 2009)
Best of both worlds Physicians domain Joint domain Nursing domain
(Lewis R., 2009, Journal of Advanced Nursing)
Results/conclusion: 4 trials No difference in survival, recurrence, psychological morbidity Patients more satisfied with nurse follow up Telephone follow-up good alternative Costs less than of physician led follow up No statistical comparison More well conducted research is needed (Lewis R., 2009, Journal of Advanced Nursing)
(Faithfull, 2001, BJC)
Results/conclusion: No difference symptom scores over time nurse-led vs physician-led Patients received nurse-led care more satisfied Significant cost benefits (31% reduction) Evidence nurse-led follow up safe (coping symptoms, telephone support) (Faithfull, 2001, BJC)
Results/conclusion: Nurse-led symptom management clinic reduces hospitalization Toxicities controlled, costs reduce Results/conclusion: Nurse-led symptom management toxicity/side effects is possible (Mason H, 2013 ONF) (Zwinkels H, 2009, ONF)
Best of both worlds Evolution of nursing power (VBOC, 2006, Verpleegkundige toekomst in goede banen)
Be visible as a nurse Card Titles Speak openly Media newspapers/tv/internet Politics Are you a nurse or a doctor
Evidence besed practice Translate research findings in practise Use guidelines Stimulate education Work togheter with other care providers
Be visable in the public domain
Proud to be a nurse
Patients voice
Patients with voices Listen to them Collaborate with them Policy statements together Advocate for them Allliance facing Politicians Other stakeholders Organisations
Patients are the best promotion In order to be successfull Important for nurses to work together, Across employment settings and roles, To advocate on behalf of colleagues and the profession. Nurses comprise the largest professional group within healthcare and have been recognized by the public as the most trusted profession (Tomajan, 2012, OJIN "Advocating for Nurses and Nursing )
Patients are the best promotion In order to be successfull Despite nursing s strengths inherent in its size, diversity, and unique relationship with the public, the full potential for influence by the nursing profession has yet to be realized (Tomajan, 2012, OJIN "Advocating for Nurses and Nursing )
THE TURKISH EONS STORY
Participation Fatigue Workshop in1996 Milan All Spring Conventions, first in Leuven 1998 First strategic planning meeting for 1998-2002 in Brussels Masterclass Programs The study of Complementary and alternative medicine in cancer patients in Europe with 13 other countries in 2005 Online course
Grants and Awards Recieved 1000 from Novartis Pharmaceutical Company Novice Research Award and Best Poster Award EONS Grant for ECCO15 Clinical Travel Grant Life Time Achievement Award
Translation Many articles from the EONS Newsletter Post Basic Core Curriculum Extravasation Guidelines 2007 TITAN TARGET
Our contribution to EONS Had an advisory board member in EONS Served for the 4th Spring Convention in Edinburgh 2004 Sultan Kav EONS Board Member and President from 2005 to 2013 Hosting the 9th EONS Congress in Istanbul
Results and Impact 13 TITAN Courses 3 TARGETcourses The extravasation guidelines EONS provides a role model Courses, workshops, masterclasses,conventions Chemotherapy Certification Course
ASK for help use Opinion leaders Stakeholders
The first Masters in Advanced Nursing Practise (2009 Ministerie Volksgezondheid Welzijn, Sport)
Grow up
Use opinion leaders
To be visable
Take home message
Look at the donut not at the hole
Take away message Proud to be a nurse Quality care prevents mortality Let your voice hear Advanced practise Ask for help Make our own future